Provider Demographics
NPI:1124105705
Name:IRA CHERNOFF,MD PCI
Entity type:Organization
Organization Name:IRA CHERNOFF,MD PCI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/FIRST ASSIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DI BELLA-PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-CFA
Authorized Official - Phone:631-246-6100
Mailing Address - Street 1:2500 NESCONSET HWY BLDG 20A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2564
Mailing Address - Country:US
Mailing Address - Phone:631-246-6100
Mailing Address - Fax:631-246-9464
Practice Address - Street 1:2500 NESCONSET HWY BLDG 20A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2564
Practice Address - Country:US
Practice Address - Phone:631-246-6100
Practice Address - Fax:631-246-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302541363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B81891Medicare UPIN
2E9241Medicare ID - Type Unspecified